Abstract
BackgroundDue to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients.MethodsNurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department’s quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit.FindingsOverall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives.InterpretationThis study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.
Highlights
During the 20-month period from July 2010 to March 2012, data were collected on 10,105 patient visits that were recorded in the Karoli Lwanga “Nyakibale” Hospital Emergency Department database
This study aims to describe outcomes of patients treated by midlevel (ECP) providers in emergency care, throughout the study period, volunteer emergency physicians were variably present in the Emergency Department (ED) for the purposes of bedside and didactic teaching
A lack of emergency care services combined with a healthcare workforce gap in sub-Saharan Africa (SSA) prompted the novel application of a task-shifting model to train midlevel providers at this rural Ugandan Emergency Department
Summary
In resource-limited settings, these emergency conditions are amplified by a lack of primary healthcare and deficiencies in health infrastructure and public safety measures. Especially in rural areas, treatment of patients with acute illness and injuries falls on non-physician clinicians who are not trained to recognize emergencies and intervene in a timely fashion. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients
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